Liver Survey Participate in Liver Research Explore clinical research studies in Columbus Ohio for people with Liver Disease. Complete this short survey to see if you qualify Please tell us about yourself so that we can find suitable study locations near you. All the information you complete will remain private. First Name Last Name Email Primary Phone Mobile Phone Address Apt. / Ste. City Zip Code We need this information calculate your body mass index (BMI). Height (Feet) Height (Inches) Weight (lbs) Date of Birth Gender Male Female Other Please choose the race and/or ethnicity that describes yourself. Choose all that apply: Hispanic or Latino American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Prefer not to say Have you been diagnosed with, or suspected to have liver disease? Yes No Do you have any of the following health conditions? Cancer in the last 5 years Poorly controlled diabetes (i.e., not on any treatment) Allergies to medications such as opioids, NSAIDS, etc Cardiac Disease (e.g., myocardial infarction, seizures, stroke, etc.) Kidney Disease Respiratory disease (such as COPD, history of P.E., etc.) History of HIV, Hepatitis B, or Hepatitis C How did you hear about us? Your privacy is important to us. Please confirm that you have reviewed our Privacy Policy and agree to the Terms of Use. Yes, I have reviewed the privacy policy and agree to terms of use Send More Information on Liver Disease The Link Between Weight and Liver Health Time to Learn the Hepatitis ABC's 5 Different Types of Liver Disease The Consequences of Cirrhosis Liver Health Plans Include Fibroscans